I read with interest the article published in the Washington Blade stating that the Republican candidate for Delaware’s 14th Representative District supports LGBTQ rights and specifically “legislation protecting transgender people.” I am glad that this lifelong Delawarean and resident of the legislative district with the largest number of LGBTQ people in Delaware is in support of our community. I do not question what is in his heart. I also do not care what is in his heart or the heart of any person seeking or serving in elective office. I care only about what they have done before they decided to seek public office, and what they do once in office.

I served on the board of Delaware Stonewall Democrats and its successor Delaware Stonewall PAC from 2006 to 2021. During that period, I served as either political vice president or president. I was heavily involved with the passage of all LGBTQ legislation in Delaware. That involvement included the passage of Hospital Visitation Rights and anti-discrimination laws in 2009 up to and including the passage of both marriage equality and transgender protections in 2013. I never saw Republican candidate Simpler at any event, fundraiser or lobbying effort for our bills.

It is because Simpler, from a local politically active family, is not known to ever actively support the efforts of our community, a community with a significant number of voters in the district he seeks to represent, that I must question the motives behind his expressing his support in the Blade now. I have not seen such expressions of support in his campaign literature or advertising supporting his candidacy. Delaware, and this area, have had more than their share of office seekers, of both parties, expressing their support, even love, for the LGBTQ community and then doing NOTHING to advance our rights once elected. I fear Simpler is just the latest. However, there is a clear alternative.

Claire Snyder Hall is the Democratic candidate. She is also a member of the LGBTQ community and, in her personal capacity and during her years as executive director of Common Cause, Delaware, has supported and even lobbied for all the legislation mentioned above. Knowing that, LGBTQ members of the 14th Representative District, and their allies, have no reason to look beyond Claire to find a representative who we know will have our backs — it is her back too. Claire is the former chair of the 14th Representative District Democratic Committee, during my term as chair of the Sussex County Democratic Committee, and she is endorsed by Delaware Stonewall. I thank Simpler for “supporting” our community and transgender rights. However,  I support and have contributed to Claire Snyder Hall, who has a track record of helping us achieve those rights.     

Mitch Crane is a former president of Delaware Stonewall PAC and a resident of Lewes, Del. 

The Biden-Harris administration has a historic opportunity to help end HIV. New, cutting-edge drugs that prevent HIV are hitting the market, but insurance companies are trying to twist the rules to deny access to these remarkable therapies.

The White House could stop these abuses and put the country on the right course for decades ahead and prevent hundreds of thousands of new HIV transmissions.

Pre-Exposure Prophylaxis (PrEP) drugs represent one of the strongest tools we have to combat HIV. These highly effective therapies can reduce the risk of contracting HIV by up to 99%. So far, the FDA has approved two once-daily PrEP pills, and in 2021 approved the first long-acting version of PrEP. Other groundbreaking PrEP innovations, such as a biannual dosage form, are in active development. 

PrEP is a major reason why new HIV infections dropped 12% from 2018 to 2022. Yet there’s still work to do. Currently, just 36% of people who could benefit from PrEP are using it. Racial and ethnic groups face wide disparities in PrEP uptake. For example, Black individuals constitute 39% of new HIV diagnoses but only 14% of PrEP users. Hispanics make up 31 percent of new HIV diagnoses, but only 18 percent of PrEP users.

A new federal directive, if properly enforced, could help close these gaps. In August 2023, a panel of prevention experts issued an updated recommendation to clinicians, recommending PrEP — including long-acting forms of the drugs — to people who want to prevent HIV acquisition. Under the Affordable Care Act, most newly issued private health plans must cover without patient cost-sharing to comply with this recommendation beginning this month.

Yet many HIV experts and patient advocates have raised concerns that insurers could misinterpret — or downright ignore — the task force’s decision and keep barriers to PrEP in place. 

One top concern is that insurance companies could decide to cover only one kind of PrEP, even though the task force’s recommendation isn’t drug-specific — it applies to all versions. For example, a health plan might refuse to cover long-acting PrEP and force patients to take oral pills instead. 

Yet long-acting PrEP is a critical option for many patients, such as those who struggle to adhere to once-daily drug regimens, are unhoused, or have confidentiality concerns. One study found that patients taking long-acting PrEP had a 66% reduction in HIV infections compared to those using oral pills. Another analysis calculated that long-acting PrEP could help avert 87% more HIV cases than oral pills, and could save over $4 billion over the course of a decade.

Another concern relates to insurers’ increasing use of “prior authorization,” a practice in which health plans refuse to cover certain drugs unless doctors obtain prior permission. Insurers could also force patients to try a number of therapeutic alternatives before agreeing to cover the medicine they and their doctors agreed upon — this is known as “step therapy.” There’s evidence that “prior authorization” policies may disproportionately impact Black and Hispanic individuals, who are already at higher risk of HIV.

Fortunately, these insurer-imposed barriers aren’t inevitable. The Biden-Harris administration, through the Centers for Medicare & Medicaid Services (CMS), has an opportunity to issue clear, detailed guidance that ensures health plans follow through on the legal requirement to cover PrEP for all eligible patients and at no cost.

CMS’s guidance should clarify that insurance companies are obliged to cover all FDA-approved versions of PrEP, including both daily pills and long-acting injectables. When now Vice President Harris was Sen. Harris, she introduced groundbreaking legislation called the PreP Access and Coverage Act, which would require all insurers to cover all forms of PrEP without cost-sharing and prior authorizations. So we know where she stands on the issue. 

A number of states, including New York and California, have already established similar coverage requirements and prohibitions on prior authorization for PrEP. 

A similar requirement already exists for contraception. Plans are required “to cover without cost sharing any contraceptive services and FDA-approved, -cleared, or -granted contraceptive products that an individual’s attending provider determined to be medically appropriate.”  

CMS just needs to adopt language along these lines for PrEP. Doctors — not insurance companies — should decide which drugs best suit patients’ needs.

Thanks to revolutionary research happening every day, people with a reason to be on PrEP have more options available to them than ever before. Yet insurers are intent on restricting access to these innovative therapies. New federal guidance can help combat this and if properly enforced set us on a path toward ending HIV.

Carl Schmid is executive director of the HIV+Hepatitis Policy Institute.

I submitted the column below to the Washington Post as an oped with the above headline, having no real expectations it would be published. They often publish my letters, but never when I criticize them directly. Imagine my surprise when I received an email after five days from Ryan Vogt, in the opinions section of the Post, sharing a version of the oped they had shortened to a 228-word letter, asking if I was OK with that version and saying if I was, they would consider publishing it. I wondered if he did the editing. I gave him an immediate OK to publish it. Then having heard nothing from him for a few days, I contacted him and was told “unfortunately, it is falling out of the mix of letters to be published.” My comment back to him was “no surprise.’ 

Here is the oped as I submitted it to the Post: 

When the publisher of The New York Times, A.G. Sulzberger, is given space in the Washington Post for his oped, ‘How the quiet war against press freedom could come to America’ on the threat to the free press if Trump is elected, it’s time for the free press to speak out. The Washington Post editorial board seems to either be asleep, or willing to let MAGA Republicans win. One would think their slogan ‘Democracy dies in darkness’ would compel them to speak out. 

The Post is the major newspaper for the DMV area, and they have yet to make an editorial endorsement in the presidential race. They didn’t endorse Senator Tim Kaine (D-Va.), running against a MAGA Republican for reelection, until three days after early voting began in Virginia. They have yet to endorse any congressional candidates in Virginia when we know there are a host of MAGA Republicans running who have endorsed Donald Trump and his platform.

I understand newspapers report the news, but then reporting, and editorial content, are two different things and should be separate. Now it would be nice if editors suggested to their reporters, like it seemed they did when writing about Biden and appending his age to every mention of him, that when reporting on Trump they would append the facts he is now the oldest man to ever run for president on a major party ticket, is a convicted felon, and been held liable for sexual assault. All verifiable facts. 

One has to question what is holding the Post back from issuing a presidential endorsement. Are they actually thinking of endorsing a man who their paper wrote tried to stage a coup on January 6, 2021. A candidate who has said he wants to be a dictator on his first day in office, and use federal agencies to get back at his enemies. If they really care about democracy, and freedom of the press, they should be editorializing for Kamala Harris every day in an effort to defeat Trump and his MAGA cult. They should be endorsing against any candidate who supports Trump, and should have done it before voting began. 

Either the editorial board is afraid to speak out, asleep at the switch, or being controlled by the paper’s owner, Jeff Bezos, who might have asked them to hold up endorsements. Are they trying to play both sides in this election in an effort to not lose subscribers? Any of those possibilities is scary, and incredibly sad, for what was once a great major newspaper. A paper owned by the courageous Katherine Graham, who was willing to stand up to a president, no matter the cost to her, or her paper. 

Does the Post’s editorial board lacking diversity have anything to do with holding up endorsements? Why are they seemingly cowering in a corner without any backbone, or willingness to stand up for a free press, and democracy. Is the fear of losing subscribers so paramount the Washington Post continues to publish MAGA Republican opinion columns, and yet won’t endorse? What principles does their editorial board believe in? What do they think will happen if the writers of Project 2025, Trump’s friends, end up in the White House, and have positions throughout the administration? What do they think, if they are thinking at all, will happen when the federal Department of Education, including its Civil Rights division, is closed? If the Federal Deposit Insurance Corp. (FDIC) is closed, and people no longer have insurance when banks go under, do they care? From the editorial board’s lack of action, it would seem they either don’t care, are in favor of those things, or don’t understand the ramification of those possibilities. 

The Washington Post, a once respected paper, owned by Katherine Graham who was willing to stand up for democracy, is now just a ghost of what it once was. If Trump wins because they lack the courage to speak out, they could become totally irrelevant. This is not a time for looking the other way, or thinking they have to be fair to all sides, when one side will destroy what they claim to stand for, a strong democracy and a free press. As early voting continues in Virginia, with no endorsements form the Post, and ballots are sent out in D.C. and Maryland, shortly what the Post editorial board does won’t matter. They will just be another paper, with a big megaphone, they refused to use. 

Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.